Sri Lanka is in the midst of the worst socio-economic crisis in its history, and the once robust health-care system is nearing collapse, with patients at risk from power shortages, a lack of medicines, and equipment shortages.
When Ruchika found out she was pregnant with her second child, in October 2021, she could not have imagined that she would find herself, hours before delivering her baby, in a crowded distribution queue, pleading for fuel to get to the hospital.
"The majority of the crowd was sympathetic," Ruchika recalled. "The authorities allowed me to buy the fuel I needed after examining my medical documents to confirm my story, but there were still a few who were shouting at us."
Pregnant women in Sri Lanka find themselves in a world that was unimaginable just a few months ago. The crisis is critically undermining sexual and reproductive health services, including maternal health care and access to contraception, and services to prevent and respond to gender-based violence have also been compromised.
Patients asked to supply medical equipment
Ruchika made it to the hospital the day after her harrowing wait for fuel, just in time to deliver her baby. But fuel was not her only concern.
Two months before her due date, Ruchika heard that women were being asked to supply gloves, blades and other basic materials needed for safe childbirth when they visited the state hospital to deliver. "The hospital had run out and had no way to replenish their stocks," Ruchika recalled.
She was terrified. "I immediately called my doctor and asked about the availability of materials and if I needed to make preparations as well. 'We have the material for now,' is what he told me," she said. "But he couldn't give me any assurances about what the situation would be in two months for my delivery. I was worried about how bad things would get so I asked my doctor twice if my baby could be delivered safely even if it was two months early."
The doctor refused, citing risks to the baby's health. "He assured me that as long as I got to the hospital in time he would make sure we were both healthy - but even that was such a struggle."
She ended up not only worried about her own access to fuel, but also that of the hospital staff. "The week before my delivery, my husband asked about my doctor's fuel status because we'd heard so many stories of doctors and nurses not being able to report to work because of the fuel crisis," she said.
World Bank/Dominic Sansoni (file)Mobile health education van in rural Sri Lanka
Appeal for funds
Ruchika's family continues to struggle. When her four-and-a-half-year-old daughter got sick, they had to go to six pharmacies to find the nebulizer she needed. And weeks after giving birth, Ruchika is well past the date she was due to get her stitches removed. She is waiting for her doctor to let her know when she can come in. Right now, the doctor is required to save the limited fuel he has to travel only when one of his other patients goes into active labour.
"The current economic crisis has far-reaching consequences for women and girls' health, rights and dignity," said Dr. Natalia Kanem, Executive Director of the UN sexual and reproductive health agency, UNFPA. "Right now, our priority is to respond to their unique needs and safeguard their access to life-saving healthcare services and support."
An estimated 215,000 Sri Lankan women are currently pregnant, according to data from the Sri Lankan Ministry of Health, including 11,000 adolescent girls, and around 145,000 women will deliver in the next six months.
UNFPA is appealing for $10.7 million to urgently meet the sexual and reproductive health needs, and protection needs, of women and girls in Sri Lanka. This funding would go towards life-saving medicines, equipment and supplies, including supplies for the clinical management of rape and services for domestic violence survivors.
It would also supply 10,000 delivery, maternity and dignity kits and provide more than 37,000 women with cash voucher assistance for reproductive health services, expand services for violence survivors, and support 1,250 midwives.
Still, with infrastructure and transportation challenges, childbirth could remain a life-threatening prospect for those unable to access skilled medical care.